Medical surveillance limitations

A medical surveillance program is designed to protect the workers health. Given the limitations of industrial hygiene monitoring data and the many hazards involved in hazardous waste activities, medical surveillance data may provide the only indication that worker exposure to toxic substances has occurred. 

The HAZWOPER was developed to protect the health and safety of workers engaged in operations at hazardous waste sites, hazardous waste treatment facilities, and emergency response locations. HAZWOPER covers issues such as training, medical surveillance, and maximum exposure limits. 

Biosafety Level 2 (BSL-2) Similar to Biosafety Level 1 and is suitable for work involving agents of moderate potential hazard to personnel and the environment. Required practices are BSL-1 practices plus limited access, biohazard warning signs, sharps precautions, and a biosafety manual defining any needed waste decontamination or medical surveillance policies. 

The standard presents OSHA s determination that exposure to cotton dust presents a significant health hazard to employees and establishes permissible exposure limits for selected processes in the cotton industry and for non-textile industries where there is exposure to cotton dust. The cotton dust standard also provides for employee exposure monitoring, engineering controls and work practices, respirators, employee training, medical surveillance, signs and record keeping. 

In medical surveillance, biological monitoring is a preventive medical tool that is used to discern the human toxicity of potential toxicants at exposure levels present in the workplace. Evidence of human toxicity can result from individual hypersusceptibility, inadequate exposure limits which might have been derived from animal data, or unsuspected... 

Periodic medical surveillance. The health status of employees should be reviewed periodically to ensure that no work-related illnesses have developed. Reviews may be limited to appropriate organ(s) or organ system(s). The frequency of reviews is related to the potential hazard(s). 

Children s Susceptibility. A limited number of human studies have examined health effects of CDDs in children. Data from the Seveso accident suggest that children may be more susceptible to the dermal toxicity of 2,3,7,8-TCDD (chloracne), but it is not known if this would be the case for other effects. Follow-up medical surveillance of the Seveso children (including measurement of serum 2,3,7,8-TCDD levels) would provide information on whether childhood exposure would pose a risk when the individual matures and ages. The available human and animal data provide evidence that 2,3,7,8-TCDD can cross the placenta and be transferred to an infant via breast milk. Although information on the developmental toxicity of CDDs in humans is limited, there are extensive animal data that the developing... 

Annex II of European directive 98/24/EC is designed to contain a list of biological limits and provisions for health surveillance for defined chemical agents. At the present time, only one limit value for lead and its ionic compounds has been determined, which is 70 pg/100 mL blood. Medical surveillance is required, if the blood lead level is greater than 40 pg/100 mL blood or if the concentration of lead in the air has been found to exceed 0.075 mg m calculated as a time-weighted average over 40 h per week. For more information see Section 6.5.3. 

The purpose, proper use, cleaning, maintenance, storage and limitations of respirators and personal protective clothing The purpose for, and a description of the medical surveillance program required by the chemical-specific regulations cited ... 

It is difficult in the laboratory to monitor the exposure levels as recommended above, but monitoring should be performed wherever possible. Even partial data or data taken under nonstandard conditions are better than none at aU. As a supplement to a monitoring and exposure limitation program, those individuals who actively use solvents as a routine part of their job a significant portion of their time should participate in a medical surveillance program. Individuals should receive a pre-employment examination, which should include a prior work history and medical history. The examination should emphasize the nervous, cardiovascular respiratory, and reproductive systems as well as the hver, kidneys, blood, gastrointestinal tract, eyes, and skin. A comprehensive blood panel should be run as well as a complete blood count and a urinary test. 

The well known hepatotoxicity of nitroaromatic compounds such as trinitrotoluene lends suspicion to the hepatotoxicity of the nitroparaffins." Nitromethane and nitroethane produce steatosis in animal models, but there is limited evidence of hepatotoxicity of these agents in humans." Evidence for the hepatoxicity of 2-nitropropane has been raised by case reports and case series of oeeupational fatalities in settings of severe exposure. In these cases the lack of appropriate industrial hygienic measures such as adequate ventilation, and personal protective equipment contributed to the severity of the exposures. " Autopsies of the fatal cases revealed hepatocellular necrosis and fatty infiltration of the liver. No significant evidence of hepatotoxicity has been demonstrated below the ACGIH TLV of 10 ppm. Medical surveillance of workers exposed to less than 25 ppm of 2-nitropropane have not shown alterations in liver chemistries. ... 

Other OSHA standards setting forth permissible exposure limits (PELs) apply to the extent that they require limiting exposures to below the PEL and, where the PEL or "action level" is routinely exceeded, the Laboratory Standard s provisions require exposure monitoring and medical surveillance. The requirements for exposure monitoring and medical surveillance are found in Appendix A, sections (d) and (g) of the Laboratory Standard. 

The Laboratory Standard also requires quite detailed record-keeping, particularly with regard to records of exposure monitoring and medical surveillance, in those circumstances where exposure limits are exceeded or where work with especially hazardous substances is conducted. 

The OSHA lead standard for general industry (29 CFR 1910.1025) was promulgated on November 14, 1978. It applied to all occupational exposures to lead except those associated with constmction or agricultural work. The key components of the lead standard were the setting of a permissible exposure limit (PEL) of 50 pg/m as an 8-hour TWA and the institution of a medical surveillance program for all employees who are or may be exposed above the 8-hour TWA action level (30 pg/m ) for more than 30 days per year. 

Terminology used by the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) to state the level of toxicant that requires medical surveillance and training to further protect employees. It is usually one-half the level of the permissible exposure limit. Action levels exist for only a few air contaminants, such as lead, cadmium, and benzene. Activated Charcoal... 

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